HB 2348/Nursing Home Staffing - Consumer Voice · 2014-04-01 · KABC & AARP KS HB 2348 •The current standard is 1.85 average hours in 24 hours, with a weekly average of 2 hours

Preventing injury, illness and death through improved nurse staffing

HB 2348/Nursing Home Staffing

Kansas Advocate for Better Care // AARP Kansas

KABC & AARP KS HB 2348

•The current standard is 1.85 average hours in 24 hours,

with a weekly average of 2 hours per resident/dat

1 nursing staff for every 30 residents

- 4.8 min = RN

- 28.8 min = LPN

• Resident acuity has substantially increased since the

standard was adopted more than 30 years ago.

With no corresponding increase in the minimum

standard for nursing care.

Your own sub headline

Current Kansas Standards


Current Guidelines Nurse staffing in Kansas nursing homes

Currently, nursing homes are directed by

guidelines to provide a minimum of 2 hours of

nursing care to each resident each day. There

is a staffing ratio requirement of:

• 1 CNA for 30 residents and

• 1 licensed nurse for 60 residents and

• there must always be two nursing

personnel in the building (regardless of

number of residents)

These requirements have not been updated or

adjusted for increased resident needs since

they were adopted in 1980.

120

1320

Current Guidelines

Nurse staffing/min

Remainder of the day/min

What it proposes

HB 2348


Training Public Notice of Staffing

.

Civil Monetary Penalties

HB 2348 requires an adult care

home to conspicuously post the

current number of licensed and

unlicensed nursing personnel --

RNs, LPNs, nurse aides, nurse

aide trainees, medication aides

and paid nutrition assistants –

who are directly responsible for

resident care and current ratios of

residents to licensed and

unlicensed personnel for each

wing and each shift.

The bill sets in statute the

training requirements for

unlicensed staff and paid

nutrition assistants, consistent

with the requirements currently

set in Kansas regulations.

HB 2348 increases the cap on

the maximum amount a facility

can be fined for noncompliance

with state and federal

requirements from $2,500 to

$3,000. The maximum fine for

citations for repeated

deficiencies over an 18-month

time period also is increased,

from $5,000 to $6,000

KABC and AARP KS HB 2348

Comments made by residents and staff as documented in reports

citing Kansas nursing homes for inadequate nurse staffing.

"Staff don't get me up as much as they used to. I

only get up in the evenings now."

-- Resident

The facility "does not have enough staff. We

are always short and things slide when we are

short." -- Staff member

"It is hard to get this all done with only 2 aides. We also have the showers and

meals to do.” -- Staff Member

• Facility cited for failing to ensure

the daily staff posting available and

prominently displayed for residents,

and visitors, and failed to maintain

the retention of the daily posted

staffing schedules for 18 months.

• The facility failed to ensure

adequate staff for 4 residents at risk

for pressure sores related to

repositioning

“The staffing is low; I wear a diaper because they do

not get me to the bathroom in time.”

-- Resident

It's not the staff's fault, there is not enough of them.

-- Resident


The results of low nurse staffing

Resident Outcomes

Incontinence

Pressure

Sores

Unnecessary

Medications

Dehydration

Falls

Other health and

safety issues


According to CMS data, more than 69% of Kansas nursing home

residents are taking antipsychotic medications, about 4% higher than

the U.S average.

KDOA/KDADS issued cited 407 Kansas facilities with 636

deficiencies related to unnecessary medications from 2009-2012.

Decubitus ulcers, commonly known as pressure sores or bed sours, are

entirely preventable if a person is receiving adequate care.

KDOA/KDADS issued cited 136 Kansas facilities with 198

deficiencies from 2009-2012.

Incontinence that is not properly managed can contribute to the

development of bladder and kidney infections. Incontinence can also

increase the risk for skin rashes and pressure sores and falls.

KDOA/KDADS issued cited 529 Kansas facilities with 1,153


Avoiding injury, illness and death

2 hours isn’t enough

2

Incontinence

Pressure sores

Unnecessary

medications


Dehydration is among the most common outcomes of poor care. It is

associated with infections, pressure ulcers, anemia, hypotension, confusion

and impaired cognition, decreased wound healing and hip fractures. When

hospitalized for an acute illness, malnourished or dehydrated residents suffer

increased morbidity and require longer lengths of stay.

KDOA/KDADS issued cited 123 Kansas facilities with 1766 deficiencies

related to dehydration from 2009-2012.

Nursing home residents are at risk of injury or death as a result of falling.

Frail elders with muscle weakness, chronic conditions that make walking

difficult, medications, and environmental hazards all increase the risk of

falling

KDOA/KDADS issued cited 705 Kansas facilities with 1,640


An inadequate number of nursing staff can contribute to all of the above

resident outcomes as well as a host of others, such as poor dental care,

cleanliness and safety issues.

KDOA/KDADS issued cited 106 Kansas facilities with 131 staffing


Avoiding injury, illness and death

2 hours isn’t enough

Inadequate

nurse staffing

Falls

Dehydration

Phased-in over three years

Year 1

Nurse staffing improvements

HB 2348

Minimum nurse staffing care: 2 hrs. 50 min/resident/day

27 min = LPN care

40 min = RN care

1 hr. 43 min = Nurse Aide care

40 27 103

1270

Year 1

RN/min

LPN/min

Nurse Aide/min


KABC & AARP KS


Year 2


HB 2348


35 min = LPN care

51 min = RN care


51 35 133

1221

Year 2

RN/min

LPN/min

Nurse Aide/min


KABC & AARP KS


Year 3


HB 2348


42 min = LPN care

62 min = RN care


62 42 162

1174

Year 3

RN/min

LPN/min

Nurse Aide/min


KABC & AARP KS

Your own sub headline

The cost of poor care


tReal savings have been documented in

other states. The University of Utah found

that increasing the ratio of nurses to

patients enough to all nurses to spend 30-

40 min./day with a ptient resulted in an

annual savings to Medicaid of nearly

$3,200 per nursing home resident.

For Kansas, that could mean a potential

savings of up to $32 million.

Cost savings

“The cost of poor care in America’s

nursing homes is staggering, whether it is

measured by poor health outcomes and

the number of lives lost, or by the amount

of money spent on treating preventable

conditions. While the trauma inflicted upon

nursing home residents and their loved

ones is not easily categorized and

calculated, the financial costs are

quantifiable. The financial burden of poor

care rests not only on individuals and

families, but also on all American

taxpayers, through Medicare and

Medicaid.” – The Consumer Voice

Improved health outcomes

2 1

1. It is time to update the standard

of nursing home care to meet

current recommendations thus

avoiding illness, injury and

death.

2. The Quality Care Assessment

Fund was created to “finance

initiatives to maintain or improve

the quantity and quality of skilled

nursing care” in Kansas

facilities.

3. This offers meaningful

employment opportunities in

communities across Kansas as

well as reducing the high rate of

turnover in nursing homes.


HB 2338 A win-win opportunity

Improved resident

outcomes

Employment Opportunities

Quality Care Assessment

Fund

Documents

HB 2348/Nursing Home Staffing - Consumer Voice · 2014-04-01 · KABC & AARP KS HB 2348 •The current standard is 1.85 average hours in 24 hours, with a weekly average of 2 hours